All about Trulicity, Ozempic, Victoza, Bydureon, and others. An Intro to GLP1s

one of the most interesting classes of diabetes medications that we have is a family called glp-1 agonists I know weird science words but it's gonna make sense I promise before these medications came around most older diabetes medications had only like one maybe two effects that helped them lower your blood glucose but newer medications like Victoza by durian trulicity and O's empik affect your blood glucose in multiple very interesting ways welcome to sugar hi guys I'm PA David your glycosylated guide and today's video is all about GLP once these medications have some of the most remarkable

actions of all diabetes drugs and have really begun to change the landscape of medical diabetes treatment so let's talk about action benefit risk and cost on this episode of sugar high [Music] in order to really explain how these medications work I kind of have to give you a little bit of background on an adorable little hormone called glp-1 glucagon-like peptide one which is much easier to refer to as GOP one is a hormone made by your intestine that has a whole lot to do with managing your blood sugar that comes in after we eat a

meal which is perfect because GLP almost looks like it spells gulp right stupid it's dumb but now you'll never forget so when we go down a meal our intestine senses that and sends out this hormone to let other parts of your body know that food and sugar is on the way glp-1 tells your pancreas dude get ready to start producing insulin and bring that sugar down oh and stop making glycogen which is a hormone that brings your sugar up it also has an effect on your brain to make you feel less hungry so that we

know when it's time to stop eating if the brain never shut off that signal making us feel hungry we'd constantly feel like compelled to eat but you know that feeling of being really full after a huge meal where you feel like like you might be like sick if you take one more bite well GOP one is partially responsible for making you feel that way that same food that you're craving 30 minutes ago now it just seems gross it also tells the stomach to hang on to that food for a while and don't send it all

to the insulin absorption all at once it's like dude give me a minute to take in these nutrients gradually instead of blasting it all in together in addition to that glp-1 makes your muscle tissue more sensitive to insulin so that the muscle cells soak up the glucose more easily one of the core problems in type 2 diabetes is that the effect of this glp-1 hormone is decreased g-o-p one is still there but it takes a lot more than normal to have the same effect on managing your blood sugar so the result of that is that

the pancreas doesn't make as much insulin as it should after a meal to push those sugar levels back down if you watched my video on how insulin works you might remember that the amount of insulin the pancreas secretes changes big-time after a meal when they measured the amount insolent put out after eating that amount was much lower in people with type 2 diabetes when compared to people without diabetes in addition to that the pancreas keeps on cranking out glycogen which raises your sugar even though the sugar levels are already going up well the whole idea

of using medications in the GOP one class like Victoza by durian trulicity and O's empik is to increase the amount of glp-1 in your body in order to restore that normal GLP action we're adding more this is basically artificial glp-1 that's kind of tweaked a little bit so that your body doesn't break it down right away so it's kind of like increasing the volume you love your voice so that you can get the message across to somebody who's hard of hearing and if it works we can help to improve excessive hunger feelings improve sensitivity to

insulin and get the pancreas to put out a better amount of insulin when you leave you know I know what you're thinking you're thinking wait a minute PA David I watched your video on sulfonylureas like glipizide implied right and you said that they work by making your pancreas make extra insulin then you said you're not really a big fan of those medications right so how is this any different and to that I say very good you're super smart and I'm totally impressed that you thought to ask that question so here's the deal remember how I

told you guys in that video this Silvano ureas tend to relentlessly make the pancreas release extra insulin to the point that it can be unpredictable and cause a bunch of hypoglycemia glp-1 is way smarter than that glp-1 only has its effect on insulin when your glucose levels go up in other words when your glucose comes back down then normal glp-1 sort of shuts off the effect of making your pancreas secretes your insulin it's not gonna keep shoving your glucose lower when it approaches the normal level so we get way less hypoglycemia with glp-1 medications if

any at all and it tends to protect insulin producing cells in your pancreas rather than wearing them out so it doesn't accelerate your dependence on insulin injections the way so final ureas can oh alright let's introduce the members of the family I'm gonna give you a general overview of each medication in the glp-1 family at least those that are available in the United States since that's where I work and that's what my experience is but this is just an introduction I'll make a detailed video on every single one of these things along with demonstrations and

dosing information and instructions on how to use it so if you're hoping for more specific information about one drug or another take a look at the upper right corner as we do this because as I make these videos I'll come back to this one and add a link okay if you're watching this shortly after I post it and the link isn't there yet don't worry just hit subscribe and the bell and you'll get a notification when those videos pop up and it doesn't cost you anything so since glp-1 is a protein style hormone they've always

only been available as an injection since stomach has to digest these hormones if you swallow them and pill form so when they first came out they kind of blew everybody's mind because you know since they're injections for diabetes they're often mistaken for like a new type of insulin and that even still happens now but do not be fooled these are not insulin just because it's injected doesn't make it insulin the very first glp-1 medication to ever be made available was called by Etta I don't have a sample of it to show you because well buy

it is still around it doesn't get nearly used as commonly as it used to mostly because of the fact that it's a very short acting glp-1 and it needs to be injected twice a day you'll see in a second that we have other members of this family that are injected much less frequently than twice a day so when those became available almost everyone switched to one of the newer options because why not right Victoza came along after by Etta and I would normally have a sample of that to show you but I ran out so

let's just pretend there's one here boom digitize it in how about that alright that's what it looks like all right whatever but what the big advantages of Victoza overfly etta is that it lasts longer and it only has to be injected once a day instead of twice a day even though Victoza is the second oldest glp-1 medication that we have it's actually still really commonly used Victoza is normally used as a standalone injection but it's also available in a combination with an insolent called tres eva the combination of true Seba and Victoza in the same

pen is called zalta fire so Victoza plus this equals this by durian is the same medication as Byetta but in a form that is much more long-lasting and only has to be injected once a week this was a real game-changer because it was the first diabetes medication that we ever had that didn't need to be taken every day and it sort of set a new standard for dosing with these medications it did kind of suck when it first came out because it was a powdered medication that had to be mixed with liquid and shaken up

and then drawn back in a syringe then you would eject it after that and it's kind of a nightmare to use but at least it was just once a week right since then they've developed this injector pen but it still does need to be shaken up before injecting trulicity is another one tweekly medication and the thing that really sets this apart at least in my personal opinion is that it comes in probably the most easy to use injector pen of all of them there's nothing that needs to be mixed and you never even have to

see the needle if that kind of thing creeps you out Tan's IAM was another weekly glp-1 but it's not even available anymore only because it wasn't profitable enough at a company to keep making it so we won't even bother with him a Blixen is a short-acting once daily GOP one that almost no one uses by itself however it is available in combination with the insulin lantus and that combination is called silica so and licks unless this equals this kind of like sulfur fire hose empik is a weekly glp-1 that came out after that now on

the surface there's not really anything gimmicky about as impact that really sets it apart from the others until you start looking at the clinical trials and you find that it's actually the most effective medication that we have in the glp-1 family and the most recent GOP wanted to be released is without a doubt the biggest game-changer of them all repeal sis is exactly the same medication as AHS empik but for the first time ever a GOP one medication is now available in oral form without injections what mind blow like I said this is just an

introduction to everyone in the family so that you know who's who for specifics keep an eye on my channel for videos they cover each one of these medications in detail including dosing how to use the medication with actual demonstrations specific side effects and anything else you might want to know alright so how about the downsides of these medications one of the biggest things that keeps people from using these meds actually happens before you ever even leave the pharmacy these suckers are expensive like really expensive now I know a lot of you guys are watching from

countries all over the world so forgive me if I don't know that cost specifics in your area but wherever you are these meds aren't cheap particularly when compared to things like them Foreman which cost next to nothing in the United States some of these medications can cost over $800 a month yes looking at you dude now of course nobody pays that amount of cash for these medications insurance pays for most of it if you're lucky enough to have a plan that covers it but even if your insurance covers it the copay can still be so

high that many people just still can't make it work of course not all costs are financial so let's talk about side effects of GOP ones since these are intestinal hormones whose job it is to slow down digestion and make you feel full kind of makes sense that the most common side effect is nausea right remember that this is the hormone that gives you that feeling of blah you know when you're up when you're full when you don't want to eat anymore with these medications the most common complaint that I hear is that they make people

feel sick now there are some differences from one med to the next in terms of how bad the nausea tends to be but for each one of them nausea and sometimes with vomiting is for sure the most common side effect accompany that with almost every other image gastrointestinal adventure you can think of like bloating diarrhea constipation and flatulence oh you're back to your old tricks from the metformin video huh I swear you are such a child there are some other things about glp-1 medications that are really rare but still deserve to be talked about since

I don't want to hide anything from you guys remember how part of this medications action is on the pancreas there have been cases of people who have developed an irritation of the pancreas called pancreatitis after using those medications this doesn't happen very often but if someone does have a history of pancreatitis especially if we don't know what caused it in the first place we tend to avoid using these medications just in case some people have also developed gall stones when taking these meds and since it slows down how fast the stomach empties into the intestine

we try to avoid using them in people who have gastroparesis which is sort of like a paralysis of the stomach that keeps it from churning and digesting but the one that really freaks everyone out when they read it in the package insert this stuff does what is a black box warning about medullary thyroid cancer depending on how new the medication is almost every glp-1 medication has an FDA warning about medullary thyroid cancer in a condition called multiple endocrine neoplasia - so I'm gonna tell you the story here since I'd rather you hear from me in

context the four medications are ever studied in humans they're studied in animals to make sure that they're safe when rodents like rats and mice were given glp-1 medications they tended to develop a really rare type of thyroid cancer called the medullary thyroid carcinoma in humans this type of thyroid cancer is super rare but rats tend to get it much more commonly than humans even without the medications when they tested it in dogs dogs did fine when they tested it in monkeys monkeys did fine and as I understand it no human being has ever been found

to develop medullary thyroid cancer as a result of taking glp-1 medications through this process they learned that the thyroid of a rat is totally different than other animals including humans so if you happen to be a rat do not take glp-1 but if you're human there's no evidence that it's likely to increase your risk of thyroid cancer but because of the fact that they found it in rats the FDA still issues a warning that if you have medullary thyroid cancer not just any thyroid cancer but specifically medullary thyroid cancer which is one of the most

rarest forms then you should probably use it another medication just in case I hope that that was a fair way to give that information because I don't want to minimize the need for caution but I also think that getting the full story and getting the information in context so that you can understand it more completely is more appropriate than just saying why to try this medication caused by our cancer rats as it turns out though not all side-effects are bad since GOP ones tend to reduce the appetite many people taking them tend to lose weight

for most people with type 2 diabetes weight loss is a great thing and it helps to improve the diabetes in general that's not a substitute for a good diet and exercise but we'll take what we can get right over the past few years we've also learned that in addition to just lowering blood glucose and helping with weight loss several of the glp-1 medications also reduce the risk of cardiovascular disease okay now I always hate it when videos or websites makes them like BS claim and they're like studies have shown in order to try to give

that BS claim credence so if you want to know if I'm telling the truth I'm gonna link the actual studies in the description below so you can go read clinical trials if you want to tell it if I'm lying or not but studies have shown that some of the glp-1 medications can actually reduce your chances of a heart attack stroke and overall cardiovascular death there's even some early evidence that some GOP ones can even help slow down chronic kidney disease but definitive clinical trials on that possible benefit are still underway right now and guys this

is huge in addition to the fact that GOP ones lower blood glucose really well without a lot of hypoglycemia risk this is one of the biggest reasons why I personally think that these medications are a cornerstone of diabetes medication therapy people with diabetes don't die of high blood sugar they die of heart disease I would always rather control someone's die with diet and exercise and weight loss instead of medications but if that's not enough for someone and they do need a medication I'm gonna try to get him an option that might possibly save their life

but that's just me GOP ones are tragically expensive and they're absolutely not right for everyone but in general I've had pretty good luck with them in my clinical practice so there's your overview on glp-1 medications I know that was a lot of information to take in but I hope that it makes sense and I hope that it gives you some insight into what we're trying to accomplish when using medications to manage their diabetes question of the day have you used a glp-1 medication and if so what were your thoughts what were your experiences what do

you want to know more about them if you're a subscriber you may have noticed that I do my best to answer all questions in the comments is so far I've able to keep up with that and I'm certainly gonna keep trying so let me know what you want to know more about if you found this video helpful give her the old thumbs up and if you're not subscribed yet make sure you hit that button and the bell because there's a lot more sugar high coming your way [Music]